What is Bulimia Nervosa and Why this Disorder is Eating You Up?

Eating is an essential human activity because this is where we derive our nourishment to provide us the energy we need to perform other functions. However, when we have eating disorders, our bodies may not be able to cope with the required nutrients because we cannot eat normally. As a result, eating disorders can trigger various health problems that may endanger our general well-being. As one type of eating disorder, bulimia is defined as “binge eating followed by inappropriate attempts to compensate for the binge, such as self-induced vomiting or the excessive use of laxatives, diuretics, or enemas” (Encyclopædia Britannica, 2008). Some cases of bulimia can be “followed by excessive exercise or fasting” and “the episodes of binge eating and purging typically occur an average of twice a week or more over a period of at least three months, and repetition of the cycle can lead to serious medical complications such as dental decay or dehydration” (Encyclopædia Britannica, 2008).
Bulimia Nervosa How to Deal

The severity of bulimia is a cause of alarm because the Anorexia Nervosa and Related Eating Disorders, Inc. (ANRED, 2005) claimed that “four percent (4%), or four out of one hundred, college-aged women have bulimia”. It is also claimed that “50% of people who have been anorexic develop bulimia or bulimic patterns”. Since bulimic people are often secretive about their condition, “it is difficult to know how many older people are affected” (ANRED, 2005).

Guertin (1999) described that the binge itself usually occurs in secret, most commonly at home during unstructured afternoon or evening hours Bulimic individuals typically gag themselves to induce vomiting. Most attempt to conceal their behavior. Fear of gaining weight is a constant factor. Although an overconcern with body shape and weight is a cardinal feature of bulimia and anorexia, bulimic individuals do not pursue the extreme thinness characteristic of anorexia. Their ideal weights are similar to those of women who do not suffer from eating disorders. A binge typically lasts from 30 to 60 minutes and involves consumption of forbidden foods that are generally sweet and rich in fat. Binge eaters typically feel they lack control over their bingeing and may consume 5,000 to 10,000 calories at a sitting. One young woman described eating everything available in the refrigerator, even to the point of scooping out margarine from its container with her fingers. The episode continues until the binger is spent or exhausted, suffers painful stomach distension, induces vomiting, or runs out of food. Drowsiness, guilt, and depression usually ensue, but bingeing is initially pleasant because of release from dietary constraints.

Like anorexia, bulimia is associated with many medical complications. Many of these stem from repeated vomiting: skin irritation around the mouth due to frequent contact with stomach acid, blockage of salivary ducts, decay of tooth enamel, and dental cavities. The acid from the vomit may damage taste receptors on the palate, making the person less sensitive to the taste of vomit with repeated purgings. Winston (2008) emphasized that hypokalemia (low levels of potassium), dental erosion, parotid enlargement, esophagitis and the Mallory–Weiss tears of the esophagus are the complications that may develop from having bulimia. Cycles of bingeing and vomiting may cause abdominal pain, hiatal hernia, and other abdominal complaints. Stress on the pancreas may produce pancreatitis (inflammation), which is a medical emergency. Excessive use of laxatives may cause bloody diarrhea and laxative dependency, so the person cannot have normal bowel movements without laxatives. In extreme cases, the bowel can lose its reflexive eliminatory response to pressure from waste material. Bingeing on large quantities of salty food may cause convulsions and swelling. Repeated vomiting or abuse of laxatives can lead to hypokalemia (potassium deficiency), producing muscular weakness, cardiac irregularities, even sudden death - especially when diuretics are used.

Treating eating disorders like bulimia is difficult. A combined feeding regimen and psychotherapy might be needed to quell this condition. Van den Eynde and Schmidt (2008) recommended Cognitive–behavioral therapy (CBT) because it is “efficacious in both bulimia nervosa and binge eating disorder, but there is a need to improve outcomes further”. Also, they said that “Interpersonal psychotherapy (IPT) has… shown to have benefits although in bulimia nervosa the response has been slower than with CBT”. Delivering psychotherapy is also costly and is often hampered by limited availability, although self-help versions of CBT may help to overcome these difficulties. Van den Eynde and Schmidt (2008) also found that “pharmacotherapy is a potential treatment option for bulimia nervosa and binge eating disorder, with evidence predominantly on antidepressants”. A high dose of fluoxetine can be administered “because it is relatively better tolerated than antidepressants of other classes”. However, “combined psychotherapy and pharmacotherapy in patients with bulimia nervosa produces somewhat better outcomes than pharmacotherapy alone, but is not clearly superior to psychotherapy alone”.


Anorexia Nervosa and Related Eating Disorders, Inc. (ANRED). (2005). Statistics: How many people have eating disorders? Retrieved April 23, 2008, from ANRED: http://www.anred.com/stats.html.

Encyclopædia Britannica. (2008). Bulimia nervosa. Retrieved April 23, 2008, from Encyclopædia Britannica Online: http://www.search.eb.com/eb/article-9018019.

Guertin, T.L. (1999). Eating behavior of bulimics, self-identified binge eaters, and noon-eating disordered individuals: What differentiates these populations? Clinical Psychology Review, 19(1): 1-24. Retrieved April 23, 2008, from ScienceDirect Database: http://www.sciencedirect.com/science/article/B6VB8-3VMDX64-1/1/f01b286cf02b1ff6d0c379c40f494e58.

Van den Eynde, F. & Schmidt, U. (2008, April). Treatment of bulimia nervosa and binge eating disorder, Psychiatry, 7(4): 161-166. Retrieved April 23, 2008, from ScienceDirect Database: http://www.sciencedirect.com/science/article/B82Y7-4SB7N5V-7/1/4bc426b9ac564690d229dd5781f63bfa.

Winston, A.P. (2008, April). Management of physical aspects and complications of eating disorders, Psychiatry 7(4): 174-178. Retrieved April 23, 2008, from ScienceDirect Database: http://www.sciencedirect.com/science/article/B82Y7-4SB7N5V-B/1/08f35b60dc0906bb9b8f7f0c8f8573eb.


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